title: Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty.
abstract: OBJECTIVE
  To investigate the efficacy of manual lymphatic drainage (MLD) in the early postoperative period after total knee arthroplasty (TKA) to reduce edema and pain and improve knee range of motion.
  
  
  METHODS
  Prospective randomized controlled trial.
  
  
  METHODS
  Private hospital and functional rehabilitation clinic.
  
  
  METHODS
  Consecutive sample of patients (N=43; 53 knees) scheduled for TKA.
  
  
  METHODS
  MLD (vs no MLD) on days 2, 3, and 4 postoperatively. Both groups underwent conventional, concomitant physical therapy.
  
  
  METHODS
  Clinical assessment was undertaken pre- and postoperatively prior to and after the designated postoperative MLD sessions (days 2, 3, and 4) and at 6 weeks postsurgery. This included active knee flexion and extension range of motion, lower limb girths (ankle, midpatella, thigh, and calf), and knee pain using a numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score.
  
  
  RESULTS
  A significant group effect was observed for active knee flexion, with post hoc tests demonstrating a significantly greater active knee flexion in the MLD group when compared with the control (no MLD) group at the final measure prior to hospital discharge (day 4 postsurgery) and at 6 weeks postsurgery. There were no further group effects observed for the remaining patient-reported and functional outcomes.
  
  
  CONCLUSIONS
  MLD in the early postoperative stages after TKA appears to improve active knee flexion up to 6 weeks postsurgery, in addition to conventional care.
authors.affiliation: School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Perth, WA, Australia; Hollywood Functional Rehabilitation Clinic, Nedlands, Perth, WA, Australia. Electronic address: jay.ebert@uwa.edu.au.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Ebert
authors.forename: Brendan
authors.initials: B
authors.lastname: Joss
authors.forename: Berit
authors.initials: B
authors.lastname: Jardine
authors.forename: David J
authors.initials: DJ
authors.lastname: Wood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D004322:Drainage / Q000379:methods*; D004487:Edema; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D042601:Lymphatic Vessels / Q000503:physiopathology*; D008297:Male; D008405:Massage / Q000379:methods; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome
keywords: ADL; Arthroplasty, replacement, knee; BMI; KOOS; Knee Injury and Osteoarthritis Outcome Score; MLD; Massage; NRS; OA; ROM; Rehabilitation; TKA; activities of daily living; body mass index; manual lymphatic drainage; numeric rating scale; osteoarthritis; range of motion; total knee arthroplasty